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Difficulty: MediumPharmacological and Parenteral Therapies

An adult client is receiving continuous total parenteral nutrition (TPN) through a dedicated single-lumen peripherally inserted central catheter (PICC). The client now requires a scheduled dose of intravenous pantoprazole. Which action represents the safest practice for administering this medication?

  1. Insert a new peripheral intravenous catheter to administer the pantoprazole.Answer
  2. B
    Connect the pantoprazole secondary tubing to the Y-site port on the TPN line.
  3. C
    Pause the TPN, flush the PICC with normal saline, infuse the pantoprazole, and resume the TPN.
  4. D
    Inject the pantoprazole directly into the TPN solution bag to maintain a closed system.

Answer

The nurse should insert a new peripheral intravenous catheter to administer the pantoprazole.
Total parenteral nutrition (TPN) is a complex, hypertonic solution that must be administered through a strictly dedicated central venous line. Because the client has a single-lumen PICC currently in use for TPN, the nurse must establish a separate peripheral IV site to safely administer the prescribed pantoprazole. This prevents drug-nutrient incompatibilities and reduces the risk of central line-associated bloodstream infections (CLABSI).

Step-by-Step Solution

1
Identify the type of continuous infusion the client is receiving.
The client is receiving total parenteral nutrition (TPN) via a single-lumen PICC.
Understanding current IV therapies dictates venous access requirements.
2
Recall the safety protocols for TPN administration.
TPN requires a strict, dedicated central line. No other medications or fluids should be administered through the same lumen.
Mixing medications with TPN increases the risk of precipitation, drug inactivation, and severe bloodstream infections.
3
Determine the appropriate route for the newly prescribed medication.
Since the single-lumen PICC is completely dedicated to TPN, alternative intravenous access must be obtained.
A peripheral IV catheter provides a safe, separate route for the intermittent medication.

Key Concept

Total parenteral nutrition (TPN) requires a dedicated central venous lumen to prevent physical or chemical incompatibilities and minimize infection risk.
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Topics

Pharmacological and Parenteral Therapies

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